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El dolor crónico es uno de los problemas médicos más frecuentes y su alivio debe ser una meta terapéutica prioritaria. Los analgésicos opioides constituyen la piedra angular. Sin embargo, en dolor crónico y el potencial adictivo de estos fármacos, así como su uso indebido y el preocupante aumento de muertes por sobredosis en algunos países como EE. UU., han obligado a las autoridades de salud a implementar estrategias coordinadas para promover la prescripción segura y respon­sable para mitigar los riesgos en el uso de opioides.(AU)

Chronic pain is one of the most frequent medical pro­blems and its relief should be a priority therapeutic goal; Opioid analgesics constitute the cornerstone, however, in chronic pain and the addictive potential of these drugs, as well as their misuse and the worrying increase in overdose deaths in some countries such as the US, have forced health authorities to implement coordinated stra­tegies to promote safe and responsible prescribing, to mitigate risks in the use of opioids.(AU)

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INTRODUCTION: Giant cell arteritis (GCA) is a chronic vasculitis of middle-sized and large calibre vessels which occurs mainly in individuals aged over the age of 50. It chiefly affects the cranial branches of the arteries that originate in the aortic arch. Its most important characteristic symptoms include visual disorders, especially loss of sight; bilateral blindness, however, is infrequent. CASE REPORT: We describe the case of an 81-year-old female who visited because of sudden blindness and bilateral retroocular pain. The neurological exploration only revealed bilateral amaurosis, dilated pupils with the phenomenon of papillary escape, and no alterations to the ocular fundus. Laboratory tests showed a haemoglobin level of 12 mg/dL, ESR of 71 mm/hr and CRP of 2.3. Magnetic resonance imaging (MRI) and computerised tomography of the brain without intravenous contrast showed findings compatible with small vessel ischemic phenomena. Because a vasculitic process was suspected, orbit RMI was performed and revealed signal hyperintensity in the soft intraconal parts with respect to the extraocular muscles. A biopsy study of the left temporal artery was compatible with GCA. CONCLUSIONS: In cases of GCA with an atypical visual presentation, finding enhancement of the intraconal fat or of the optic nerve sheath in the RMI can support the suspicion of an arteritic process.

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OBJECTIVE: Enhance-L.C. is an orthodontic adhesion promoter. Our aim was to find out if this product is material-specific as stated by its manufacturers or whether its effects are similar when the promoter is used with other adhesive systems. DESIGN: In vitro study. SETTING: Dental Clinic. University of Murcia, Spain, 2002. MATERIALS AND METHODS: Enhance-L.C. was used with one of the manufacturer's recommended adhesives, Light-Bond, and with a second from another manufacturer, Transbond-XT. One hundred premolars were divided into four groups of 25 premolars: 1)Transbond-XT, 2) Transbond-XT/Enhance-L.C., 3) Light-Bond, 4) Light-Bond/Enhance-L.C. MAIN OUTCOME MEASURES: Shear bond strength was evaluated with a universal test machine and the adhesive remaining after debonding was determined using image analysis equipment. RESULTS: Enhance-L.C. did not significantly increase the bond strength of either of the two systems (P > 0.008). However, Light-Bond/Enhance-L.C. provided a bond strength significantly greater (P < 0.008) than Transbond-XT and Transbond-XT/Enhance-L.C. Light-Bond also left significantly (P < 0.05) less adhesive remaining on the enamel than Transbond-XT, whether or not either of the systems were used with Enhance-L.C. CONCLUSIONS: The use of Enhance-L.C with Light-Bond is to be recommended whenever extra bond strength is needed.

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Studies of the baroreceptor heart rate reflex were performed in two-kidney, one clip (2K1C) hypertensive rats to evaluate the relative importance of two factors--high blood pressure and high angiotensin II circulating levels--on impairment of the baroreflex, present in the acute phase of this model of hypertension. The sensitivity of baroreceptor reflex was determined by the slope of the relationship between changes in mean arterial pressure (MAP) and changes in heart rate in response to injections of phenylephrine and nitroprusside. Bradycardic and tachycardic responses were analyzed separately. In basal conditions, the slope of the MAP-heart rate relationship in 2K1C hypertensive animals was significantly lower than in control animals, both for tachycardic and bradycardic responses. Lowering of blood pressure with captopril to normotensive levels in the 2K1C animals significantly increased baroreflex gain in bradycardic responses to the level found in normotensive rats. Normalization of blood pressure with nitroprusside did not change baroreflex sensitivity. Infusion of angiotensin II at a dose that did not change MAP, previously normalized with captopril, completely reverted the effect of this agent on baroreflex sensitivity. Our data indicate that, in 2K1C hypertensive rats, decreased baroreflex sensitivity is mediated, at least in part, by high angiotensin II circulating levels. Elevated blood pressure per se is of secondary importance.

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